The Firs Residential Care Home

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant services were not planned or delivered in ways that met people’s needs.

The service was in breach of legal regulations in relation to people’s safe care and treatment and person-centred care.

This service scored 29 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people were at the centre of their care and treatment choices, this meant that people did not receive person-centred care. As demonstrated in this report, care plans were not reflective of people’s needs or wishes and had not been developed with people or relatives. Care plans and daily records did not evidence that people received personal care in line with best practice. For example, where people required support with their personal care in bed, rotas showed there were frequently not enough trained staff present to undertake this safely or responsively as 2 staff members were needed to support each person with equipment such as slide sheets. Some care plans detailed people needing support with their continence and support to change continence products on 2 and 4 hourly checks. Records showed this support was not delivered within these time frames. This meant people were placed at the risk of harm from remaining in soiled continence products for extended periods of time.

There were significant shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible or supportive of choice and continuity. We repeatedly asked for the provider’s policy and procedures which supported integration and continuity, but the documents were not received. Care plans lacked details of how staff had acted on professional feedback. For example, we saw request from professionals such as GPs for regular weight recording and repositioning however the registered manager was unable to evidence these requests or advice had been followed.

The provider did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Where people lacked capacity, they were not supported with dementia-friendly signage or picture cards to support communication and choice. The staff and registered manager were not knowledgeable or proactive in promoting the Accessible Information Standard (AIS). AIS isa legal requirement for adult social care organisations in the UK, ensuring individuals with disabilities, impairments, or sensory loss receive information in a way they can easily access and understand.

The registered manager provided assurance that there was a process in place for people to share feedback or raise complaints about their care, treatment and support. However, we did not see any evidence that people were involved in decisions about their care and staff were told about what had changed as a result. Everyone we spoke with told us they knew how to raise a complaint but not everyone felt changes or improvements had been made as a result. One relative said, “I raised a concern with [registered manager] about [name’s] care. The manager said all the right things and seemed to listen, but nothing changed. I spoke to staff to see if they were aware of my concern and the changes that had been agreed but they knew nothing about it.”

We saw some evidence of resident meetings which gave updates and opportunities for feedback, however, there was no evidence of how people, including those living with dementia and those cared for in bed had been supported to participate in this process.

We asked the registered manager for the complaints policy and a record of complaints, but these documents were not provided.

Care plans did not contain clear details of people’s needs, wishes, abilities, including potential barriers people may experience and how they could be supported to overcome these barriers to ensure equity in access. The registered manager had failed to review incident forms and seek appropriate further medical support. For example, one person had experienced repeated unwitnessed falls and the registered manager described how they thought this may be linked to an infection, but no action had been taken to have this assessed by a professional.

However, we did see some evidence of staff making appropriate referrals to other professionals when needed. For example, we saw staff contacting GPs to request a home visit for someone as they were concerned about a continuing and worsening cough.

The provider and registered manager did not listen to or record information about people who were most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this. Despite requests we were not provided with the provider’s equality and diversity policy. Staff told us they had raised their concerns about the quality of care plans which hindered their ability to provide responsive care. One staff member said, “We used to support in writing and reviewing the care plans as we know people well, we are with them every day, but we stopped doing it as the registered manager would just overwrite what we had written or change it anyway.”

Care plans we reviewed consistently failed to identify people’s current needs or evidence any outcomes from the care they had received. For example, where people required support during periods of anxiety and frustration, including physical aggression, the de-escalation support plan advised staff to leave the person to calm before attempting to support again. Only 4 staff members had undertaken training in this area which meant that staff were not supported to respond safely or promote responsive positive outcomes for people.

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. At the time of the assessment, the registered manager confirmed 2 people were in receipt of end-of-life care, however their care plan did not reflect this. Staff confirmed that one person had medicines stored in anticipation of their changing needs to ensure the person remained comfortable and pain-free. However, care plans failed to detail how and when staff should start this support and staff we spoke with were unsure of the process to follow. This meant the person was at risk of not receiving responsive care and being left in pain or discomfort during their end-of-life care.